Synovioma: symptoms and treatment tumors of the brush, a knee joint, etc
Synovioma soft tissue and joints: treatment and prognosis
By definition, the world Health Organization synovial sarcoma is a mesenchymal spindle-cell tumor with the presence of a tissue component.
One of the most formidable cancers of the soft tissues, with a high probability of metastasis to bone, lungs, lymph nodes, and other organs.
Earlier this disease was known as synovial endothelioma. It comes not from the synovial tissue, as previously thought, but later this view was not confirmed. Most often affects the lower extremities.
Are usually unilateral, affecting one of the limbs. This form of cancer is relatively rare, it rapidly progresses and metastasizes.
The cause of education
The cause of synovioma so far not clear. There is a theory about the connection of this disease with a chromosomal translocation.
Discovered factors that may cause this disease. This influence of radiation, carcinogenic effects, genetic predisposition, immunosuppressive treatment other forms of cancer, and trauma.
The disease mainly affects people under 50 years, most of whom were men.
Very often found unexpectedly during preventive examination in the clinic, as well as targeted visits to the surgeon and traumatologist.
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The disease may be asymptomatic in the initial stages, having a hidden undiagnosed period of flow, approx
of about 2 years.
Being enclosed in a capsule, synovioma like benign or bursitis. Virtually painless and hardly restricts movement.
The main complaints of patients are:
- joint pain or restriction of mobility;
- detection of the swelling;
- numbness at the site of the tumor;
- malaise, weakness;
- weight loss, loss of appetite;
- the increase in the corresponding lymph nodes;
- the increase in body temperature.
To determine the nature of the tumor is possible through the study of its contents. Taken a piece of infected tissue and examined microscopically.
On histology it is impossible to draw final conclusions. Even during the surgical intervention it is impossible to determine the character of synovial sarcoma. This can be done only after the biopsy material taken during surgery.
The possible localization of education
Synovial sarcoma is a soft-elastic to the touch the mass 2 to 20 cm, with slit-like spaces and cysts, and areas of necrosis and hemorrhage.
According to statistics, 10% of all soft tissue sarcomas presented by synovioma.
Synovioma usually localized in the area of the knee joint, and joints of the hand, thigh and calf.
Most common location:
- the joint area of the knee(31%);
- the joints of the ankle(14%);
- the hip joint(12%);
- upper extremity(12%);
- the wrist joint and palm.
Of them according to statistics, the tumor is most often localized in the region of the joint and handbags 40% in the region of the tendon sheath 20%.
In General, synovial sarcoma soft tissue found in 80% of cases, and in the joint area by about 5%.
Classification of education
There are 2 morphological types of tumor:
The type of the cellular structure of synovial sarcoma can be:
- Monophasic is characterized by the presence in the tumor tissue of the same species of cells, sarcomatous or epithelial.
- Biphase two-thirds of all tumors. In Biphase contains cells of both types. Histology is divided into
myxoid, cystic, and calcified options.
According to the microscopic structure define the following types of tumors:
- giant cell;
Depending on the location of the tumor diagnostic activities include:
- radiological examinations (allows to define the size and location of the tumor);
- angiography (detects vascular pathology);
- MRI, computed tomography (detects the presence of metastasis);
- Ultrasound (search for metastases);
- puncture of the lymph nodes;
- a biopsy of the tumor tissues (to obtain material for research on cyto and histological);
- radioisotope scanning (injection of the tracer).
Differentiation with other types of cancer
Synovioma malignant nature should be differentiated from:
- of Ewing’s sarcoma;
- sarcomatoid carcinoma;
- uterine leiomyosarcoma;
- clear cell sarcoma;
- epithelioid sarcoma;
- planetarnogo of fibromatosis;
- the carcinosarcoma;
- as well as diffuse-type giant cell tumor tenosynovial.
Use a standard set of methods of treatment of tumors of the:
- Surgical treatment is the primary treatment synovioma. Is elastyczne excision or amputation followed by radiation with chemotherapy.
- Radiation therapy: this is assigned before the operation or after it (in the case of detection of metastases). Is made in several courses within six months. Before the appointment of therapy, the patient undergoes a thorough examination and diagnosis. Ongoing postoperative radiation therapy significantly reduces the risk of relapse.
- Chemotherapy: medications prescription drugs (containing ifosfamide and doxorubicin hydrochloride). The action of these drugs is aimed at preventing further development of cancer cells. It is always prescribed for the detection of metastases.
- Narcotic analgesic drugs are used to alleviate the patient’s condition.
Relapses are from 45 to 80 percent of all cases. Metastasis in lungs from 60 to 80 percent, in the lymph nodes from 20 to 40 percent probability, and dice from 5 to 20 percent.
What chance does the patient?
The prognosis for this disease depends on the tumor size, extent of lymph node and presence of metastasis.
Adverse factors are considered to be the male gender of the patient and localization of the tumor in the deep soft tissues of the feet.
Also, some researchers suggest that the bi-phase type compared with the monophasic has the best prognostic indicators (five-year survival rate of 58 percent, versus 30 percent of monophasic).
Sarcoma with a weak cellular atypia and lack areas of necrosis are more favorable than sarcoma with severe nuclear atypia, high cellularity and areas of necrosis.
If the tumor is small and no metastasis, the prognosis is favorable (over 90 percent). But if the tumor is of considerable size (>5 cm) and started the development of metastases, the prognosis is negative.
The ten-year observation of a group of patients older than 40 years showed a survival rate of more than 25 percent of cases. And among patients younger than 20 years, the survival rate has reached 90 percent.
Thus, the prognosis is influenced mainly by three factors: clinical (age and size of tumor), histological and immunohistochemical.
Timely diagnosis and earlier treatment significantly improves survival.